Latent profile of information literacy and their predictors
Information literacy of clinical nurses runs through the whole cycle of their emergency nursing work and can help them work effectively in an increasingly information-intensive emergency environment [37]. Therefore, insights from the current study of the latent profile analysis are beneficial to hospital managers in understanding the different types of emergency department nurses' information literacy and provide a reference for them to improve nurses’ information literacy levels. Basing on the latent profile analysis, our study found significant differences in information literacy among emergency department nurses, confirming the hypothesis (a). We named them low information literacy (Class 1), moderate information literacy (Class 2), high information knowledge and support (Class 3), and high information literacy (Class 4), which were 20.14%, 42.11%, 23.36%, and 14.39%, respectively. Class 1 had the lowest level of information literacy, which indicates a major concern that should be focused on them. Class 2, accounting for the majority of the sample, had moderate information literacy, which could be the most common type of emergency department nurses' information literacy in China. A systematic review conducted in 2017 ~ 2019 identified a general lack of informatics competencies [38] which is consistent with most types (Class 1 and Class 2) in our study. Emergency nursing work is dangerous and challenging, nurses need to have information literacy in the treatment of patients with critical clinical conditions particularly [39–41].
However, as the graph in the four-class model shows, the scores for the dimensions of information awareness, information ability, and information ethics were much lower than the other dimension scores in each subgroup. The possible reason might be that although clinical nurses undertake heavy nursing work and have a lot of information needs, they are not good at actively collecting, sorting, or using information resources [42, 43]. Many nurses believe that clinical experience is more accurate than then evidence and have insufficient awareness of information [44, 45]. The low information capability of nurses is mainly due to the lack of information acquisition ability, literature evaluation ability, and clinical decision-making ability [46]. They rarely or even do not use the database to retrieve literature[47, 48]. The low levels of nurses' information ethics is mainly due to the lack of understanding of intellectual property rights, laws, and policies [49, 50].
The sociodemographic characteristics were different among the subgroups, confirming the hypothesis (b). Through our research, we found that emergency department nurses in Class 1 were younger and had lower educational level. In Class 1, the proportion of primary professional titles was higher than other group and that of the nurses who can’t use the database was larger for they spending less time on learning. Our study showed that the proportion of nurses who use the Internet and database was very small in Class 1. Research found that social media was an important way for nurses to improve their information literacy [51, 52]. An American study conducted among 349 nurses found their most common daily electronic sources of information were electronic medical records which may contain links to external sources (72%), followed by general search engines daily (39%), then websites with medical information (23%) in hospital [53]. Moreover, without digital source evaluation skills, nurses are unable to discern reliable online sources effectively [54, 55]. Class 2 and Class 4 were referred to as the ‘moderate information literacy’ and ‘high information literacy’ subtype, and both showed a similar pattern for the five dimensions of information literacy. Class 2 showed a medium level for all information literacy dimensions. The majority of emergency department nurses in the two classes shown the characteristics of spending more spare time acquiring professional knowledge, using databases to search the literature, and reading medical literature. Class 3 showed the highest score in the information knowledge and support dimension. This type of demography was characterized by older age, longer working years, higher educational level, and professional titles.
Based on the Person-Context interaction theory [56], our further study found that self-efficacy and social support were closely related to the information literacy of emergency department nurses, and were different among the subgroups, which were the predictive factors of information literacy, confirming the hypothesis (c). The Person-Context interaction theory holds that individuals and situations interact with each other. Emergency nurses are in a high-pressure emergency environment, which requires them to have good information skills. Their information literacy is influenced by a combination of internal and external factors. Therefore, we chose self-efficacy as an internal factor and social support as an external factor to explore their impact on the information literacy of emergency nurses and further analyze their differences in different types of information literacy. Compared with Class 4, lower self-efficacy and social support had a higher likelihood of belonging to Class 1. Research shows that a good sense of self-efficacy helps individuals improve their self-confidence [57, 58]. Therefore, emergency nurses with high self-efficacy can better analyze and process clinical information, and with good information literacy. Research shows that emergency nurses are under high pressure, and social support can alleviate their fatigue and stress [59]. The emergency center is the department with the concentration of critically ill patients, the most types of diseases, and the most important tasks of rescue in hospitals. Good social support can provide subjective and objective assistance to emergency nurses, broaden their information acquisition, and provide more information resources in the form of providing information training, continuing education, and information support, which is conducive to the improvement of their information literacy.
Relevance to clinical practice
In the context of information medicine, the level of emergency nurses' information literacy is low, and is difficult to meet the needs of information nursing development [60, 61]. The complex diseases in the emergency department require information technology in medical equipment and the information capabilities of medical personnel [62]. The capability of using information is essential for emergency nurses to adapt to emergency environments, allowing them to quickly solve clinical problems and critical issues [63]. In order to meet the intelligent medicine, it is imperative to improve the information literacy of emergency department nurses. Through potential profile analysis, we found that the information literacy of emergency department nurses fell into four categories, and further explored the predictive factors of different categories. These predictive factors are of great significance to improve their information literacy of different latent profile membership more targeted.
It suggests that emergency department nursing managers should combine and refer to these characteristics to improve emergency nurses’ information literacy. Compared to high information literacy emergency nurses, more attention needs to be paid to low information literacy emergency nurses. Nursing experience of more than 6 years, nurse title, not reading the literature in the past month, lower hospital grade, rural areas, less time spent in spare time to learn professional knowledge, low utilization of databases to search the literature, and not participating in information literacy training have a higher likelihood of belonging to Class 1. It implicates that more attention needs to be paid to these factors to improve nurses' information literacy levels. Our research is consistent with Nowrouzi's [64] findings that highly educated nurses have better working ability, so they can master information skills and have a high level of information literacy. Therefore, improving the education level of nursing staff and strengthening their continuing education is very important.
At the same time, emergency nurse managers should not only give full play to emergency nurses’ own initiative and self-efficacy but also give full play to the role of social support, that is, give full play to the role of internal and external factors in clinical practice. Emergency head nurses should regularly encourage nurses to increase their confidence and enhance their self-efficacy. Hospital managers support them in participating in learning and training, especially in the field of information, and increase their rewards and support through assessments or evaluations of information skills, promoting the improvement of their information literacy. Family members of emergency nurses should also fully understand and support their work, and pay more attention to them.
Limitations
There are some limitations in our study. First of all, due to the cross-sectional nature of the data, we cannot draw definite conclusions about the directionality of associations between the identified profiles and covariates. Secondly, our study was conducted in the form of a self-report questionnaire and the results tended to be subjective.